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TRANEXAMIC
ACID
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Laupacis A, Fergusson D. Drugs
to minimize perioperative blood loss in cardiac surgery: meta-analyses
using perioperative blood transfusion as the outcome. The International
Study of Peri-operative Transfusion (ISPOT) Investigators. (Anesth
Analg 1997 Dec;85(6):1258-1267)
Boylan JF, et al; Tranexamic
acid reduces blood loss, transfusion requirements, and coagulation
factor use in primary orthotopic liver transplantation. (Anesthesioloogy,
1996, Nov)
Benoni G, et al; Fibrinolytic
inhibition with tranexamic acid reduces blood loss and blood transfusion
after knee arthroplasty: a prospective, randomised, double-blind
study of 86 patients. (J Bone Joint Surg Br, 1996 May)
Katoh J, et al; Additional
postbypass administration of tranexamic acid reduces blood loss
after cardiac operations. (J Thorac Cardiovasc Surg, 1997 Apr)
Rousou JA, et al; Tranexamic
acid significantly reduces blood loss associated with coronary
revascularization [see comments] (Ann Thorac Surg, 1995 Mar)
Katsaros D, et al; Tranexamic
acid reduces postbypass blood use: a double-blinded prospective,
randomized study of 210 patients. (Ann Thorac Surg, 1996 Apr)
Hiippala ST, et al; Tranexamic
acid radically decreases blood loss and transfusions associated with
total knee arthroplasty. (Anesth Analg, 1997 Apr)
Menichetti A, et al; Changes
in coagulation patterns, blood loss and blood use after cardiopulmonary
bypass: aprotinin vs tranexamic acid vs epsilon aminocaproic acid.
(J Cardiovasc Surg, 1996 Aug)
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APROTININ
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Kesten S, et al; Aprotinin
reduces blood loss in lung transplant recipients. (Ann Thorac
Surg, 1995 Apr)
Lentschener C, et al; Aprotinin
reduces blood loss in patients undergoing elective liver resection.
(Anesth Analg, 1997 Apr)
Goldstein DJ, et al; Use
of aprotinin in LVAD recipients reduces blood loss, blood use, and
perioperative mortality [see comments] (Ann Thorac Surg, 1995 May)
Casas JI, et al; Aprotinin
versus desmopressin for patients undergoing operations with cardiopulmonary
bypass. A double-blind placebo-controlled study. (J Thorac Cardiovasc
Surg, 1995 Oct)
Utada K, et al; Aprotinin
2 million KIU reduces perioperative blood loss in patients undergoing
primary total hip replacement (Masui, 1997 Jan)
Ohuchi H, et al; Aprotinin
reduces homologous blood transfusions when pediatric cardiac surgery
must be redone (Nippon Kyobu Geka Gakkai Zasshi, 1996 Nov)
Scudamore CH, et al; Aprotinin
reduces the need for blood products during liver transplantation.
(Am J Surg, 1995 May
Prendergast TW, et al;
Defining the role of aprotinin in heart transplantation. (Ann
Thorac Surg, 1996 Sep)
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DESMOPRESSIN
Desmopressin is a well tolerated
and
convenient haemostatic drug
that can
be used in a number of clinical
conditions with bleeding diathesis.
It has several effects on the
haemostatic system, causing
endogenous release of coagulation
factorVIII, von Willebrand factor,
tissue plasminogen activator
and also
increasing platelet adhesiveness
and shortening bleeding
time.
The effect is virtually immediate
and
lasts for several hours. Side-effects
are few and mostly mild.
The optimal dosage is 0.3 microgram
kg-1 intravenously, but the
drug
may also be administered
subcutaneously or intranasally.
In addition to the established
indications, haemophilia A,
von Willebrand's disease and
platelet dysfunction, the drug
may
also be used safely in other
patients
with unexpected bleeding during
or after surgery. The effectiveness
of general prophylactic use
of
desmopressin, in order
to diminish
surgical blood loss and transfusion
requirements, has not been proven,
except in patients with known
bleeding diathesis caused by
congenital or acquired haemostatic
disorders, e.g. in those taking
aspirin.
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Castaman G et al; Pilot
study on the safety and efficacy of desmopressin for the treatment or prevention
of bleeding in patients with hematologic malignances
Haematologica 1997; 82:584-587
Lethagen S; Desmopressin--a
haemostatic drug: state-of-the-art review. (Eur J Anaesthesiol
Suppl, 1997 Mar)
Hunt BJ; Desmopressin
and bleeding during invasive surgery. (Eur J Anaesthesiol Suppl,
1997 Mar)
Josefsson G; Primary
hip arthroplasty in 14 Jehovah's witnesses. No complications related
to bleeding were reported (Lakartidningen, 1996 Sep 18)
Chuong CJ, et al; Management
of abnormal uterine bleeding. (Am J Obstet Gynecol, 1996 Sep)
Green D, et al; Efficacy
of hemostatic agents in improving surgical hemostasis. (Transfus
Med Rev, 1996 Jul)
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